Q: I am facing a shoulder replacement soon and have learned that pre- and post-care are important for the return to activity. I am active in cycling, weight training, running and other vigorous activity. Any advice on how to both prepare and recover is appreciated. — Jon Thompson, Fort Collins
A: The shoulder joint is a mechanical marvel that allows for 100-mph fastballs, 300-yard golf drives, holding a blow dryer, hammering a nail and picking up groceries.
Because you have to give up “stability” for “mobility,” the shoulder joint requires more work to control the motion; this complexity leaves little room for error and more chances for things to go wrong. Injuries to the tendons, ligaments, cartilage, cushions and/or muscles that hold or protect the whole glorious mechanism can be a major buzz kill.
Shoulder injuries account for at least 13 percent of all visits to orthopedic surgeons. Shoulder surgery is certainly an option but there are alternatives if the damage is not severe. Treatments include anti-inflammatory pain medications, steroid injections, and wearing a shoulder brace to inhibit movement.
Minor surgical procedures can include arthroscopy, which involves a small incision so that small repairs can be made. One of the latest techniques is shoulder resurfacing. This procedure allows more of the natural tissue to remain intact while only the damaged or diseased parts are replaced.
If the damage to this joint is severe and causes extreme pain and loss of function, including the onset of extremely disabling arthritis, replacement of the entire joint is an option (unless, of course, your health insurance provider has deemed that having a damaged shoulder joint in the first place is a “pre-existing condition”).
The surgery is extremely complex because bone and cartilage are removed and replaced with implants made of metal and plastic. Replacement surgery should not be taken lightly. Pain may be relieved but damage to nerves and blood vessels that affect the hand and arm can occur. Be sure to consult with your physician in depth regarding all of your options.
Assuming that your surgery was satisfactory, your post-operative rehabilitation and exercise program will probably begin while you are still recovering in the hospital. Even though your arm will be in a sling for four to six weeks, physical therapy will begin as soon as you can make a fist with the hand of your operated shoulder. Your physical therapist will also assist by passively moving the arm for you in order to keep it from getting stiff or becoming “frozen.”
According to the University of California at San Francisco Medical Center, the post-operative exercises will focus on simple range of motion and grip, such as straightening the arm at the elbow, retracting the shoulder blades, gentle rotation and circling exercises, and squeezing a rubber ball.
Once you are out of the hospital, you will be given exercises to perform that will focus on flexibility and strength. For the first six weeks movement will be limited but you will learn rehabilitation exercises. These are absolutely essential; do not fail to do them as instructed.
After those first six weeks, you will need to work with a physical therapist to regain full range of motion, strength, shoulder and shoulder blade timing (also known as “scapular humeral rhythm”), says physical therapist Stuart Wilson of Champion Sports Medicine in Denver. “Some effort may also be required to retrain the shoulder to correct bad habits that may have been there before the injury even occurred.”
Most people who work at a desk can return to their duties within a few weeks. For those who have more physically demanding jobs, it could be months. However, simple cardiovascular exercise is highly recommended. Walking and bicycling (on a recumbent machine) are great ways to get back into condition. This also helps restore good circulation, which promotes healing.
Weight training, skiing, running, swimming and other activities where the shoulder is used extensively, or where there is a risk of falling and re-injuring the shoulder, may have to be put on hold for as long as a year.
Linda J. Buch is a certified fitness trainer in Denver; linda@ljbalance.com.
